OPINION ARTICLE

PUBLIC HEALTH

published: 03 June 2014

doi: 10.3389/fpubh.2014.00059

Breakfast: to skip or not to skip?

Tanya Zilberter 1 * and Eugene Yuri Zilberter 2
1

Infotonic Conseil, Marseille, France

School of Psychology, University of Glasgow, Glasgow, UK
*Correspondence: zilberter@gmail.com
2

Edited by:
Maria Joo Guimares Fonseca, Centro de Investigao em Biodiversidade e Recursos Genticos, Portugal
Reviewed by:
Milka-Dancevic Gojkovic, Public Health Institute of Federation of Bosnia and Herzegovina, Bosnia and Herzegovina
Keywords: dietary health education, breakfast skipping, overnight fast, late eating, health risks, intermittent fasting, meal timing, calorie intake

Human eating behaviors are often nonhomeostatic, and thus unlike homeostatic
behaviors, they are not exclusively reliant
on rigid brain mechanisms, but heavily depend on psychological, sociocultural,
and educational factors as well. A clear
understanding of the mechanisms and consequences of various eating behaviors is
necessary for giving comprehensive educational guidance. However, recommendations regarding breakfast (BF) eating
behavior are perhaps the most peremptory
yet scientifically (especially metabolically)
groundless health guidelines, and thus the
widely accepted notion of BF as the most
important meal of the day has been called
into question. In a recent meta-analysis,
Brown et al. (1), not arguing with the established link between obesity and BF behavior, concluded: The current body of scientific knowledge indicates that the proposed
effect of breakfast on obesity is only presumed
true (p. 1298). The authors state that
numerous articles demonstrating negative
metabolic effects of skipping BF have yet to
establish a causal relationship due to a lack
of probative value and that the major obstacle in establishing causality is neglecting the
possible confounding factors.
In this opinion paper, we suggest that
BF is just another meal, rather than the
most important meal of the dayas is commonly believed and that prolongation of
overnight fast, which depends not only on
timing of BF but also on timing of the last
meal of the day, can be beneficial.

DEFINITION
A significant barrier to advances in the
study of BF behaviors is the lack of a
common language. It is often discussed
that there is a fundamental difficulty in
comparing different results due to lack of

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common definitions for both eating BF and

skipping BF [e.g., Ref. (2, 3)]. Currently, the
definition of BF continues to vary between
studies, although the definition by Timlin
and Pereira (4): first meal of the day, eaten
before or at the start of daily activities (e.g.,
errands, travel, work), within 2 h of waking,
typically no later than 10:00 in the morning,
and of an energy level between 20 and 35%
of total daily energy needs is accepted as an
academic standard. Of significance for this
discussion is to note that the above definition does not specify the duration of the
overnight fast.

DURATION OF OVERNIGHT FAST

The duration of overnight fast is rarely
specified in studies comparing effects of
eating versus skipping BF. As a result,
an important parameter, which can significantly influence the metabolic consequences of eating behaviors are neglected
in the majority of studies resulting in
wrong conclusions (e.g., 4; Figure 1C).
Consider, for example, two BF-eaters
having their last meals at midnight; one
then consumes BF at 5:00 a.m. (5-h
overnight fast) and the other consumes BF
at 10:00 a.m. (10-h overnight fast). Both
are considered BF-eaters in the majority
of studies, but the difference in overnight
fast durations makes them metabolically
distinct from each other. Similarly, BFeaters who have an earlier dinner (last
meal) at 7:00 p.m. followed by BF at
10:00 a.m. have an overnight fast of 15 h,
which can be metabolically similar to BFskippers who had a later dinner (midnight) and skipped BF altogether and ate
their first meal at 3:00 p.m. (same 15-h
overnight fast). The important point here
is that due to the neglect of this important
parameter in BF eating behavior studies, it

challenges the validity of their findings and

the interpretations thereof.
The above point also shines light on
potential contradictions in eating behavior literature. For example, although eating
late (practicing late dinners and/or nighttime meals) is considered a bad habit and
eating BF is considered healthy, they may
both have similar duration of overnight
fasts and thus may result in similar metabolic profiles. It is well known that late
eaters have a problem with losing weight
(5, 6) and have overall poorer health conditions [Figure 1B, Ref. (7)]. Both late
eating and BF skipping are usually listed
together as risk factors for unhealthy metabolic profiles [e.g., Ref. (8, 9)] but solid
evidence exists only for consequences of
late eating.
Late or night-time eating was found
to be linked to multiple eating behavior
pathologies, such as night-time hunger,
body image distortions, and mood disorders (10), as well as elevated blood levels
of insulin and glucose characteristic for
metabolic syndrome (11). Timing of eating behavior has both circadian and noncircadian aspects (12). The non-circadian
aspect (that is, 24-h caloric intake) allows
for a comparison between the effects of
skipping BF and excluding late eating, in
terms of duration of the overnight fast.
When late eating is excluded, as it was
in a randomized crossover design study
(13) where no eating was assigned from
7:00 p.m. to 6:00 a.m. while ad libitum
eating was allowed during the rest of the
day, the subjects consumed 244 fewer kilocalories regardless of their food choice.
The calorie intake factor is one of the
most important in determining the metabolic consequences of meals and eating
behaviors.

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Zilberter and Zilberter

Breakfast: to skip or not?

FIGURE 1 | Habitual breakfast eaters (A) and late eaters (B) have higher incidences of medical claims than breakfast skippers and early eaters.
Modified from Ref. (7). (C) Amendment to the theoretical model of BF frequency and quality in the development of obesity and chronic diseases (4).

The model proposes that regular BF

consumption can lead to increased satiety and decreased hunger [which is
in agreement with data of Kral et al.
(14) and Levitsky and Pacanowski (15)].
However, research results of Levitsky
and Pacanowski (15) do not support
this claim. The lower risk of chronic
disease suggested in the Model is in
disagreement with data depicted in
Figures 1A,B.

BREAKFAST SKIPPING: WHAT DO WE

REALLY KNOW?
To investigate the link between BF skipping, BMI, and risks of obesity, a closer
look at caloric intake may be used as

a tool to establish whether or not there

is any causality between them. Calorie
intake is considered the major determinant of BMI [e.g., Ref. (16)]. It is routinely
stated that skipping BF is overcompensated with increased energy consumption later during the day. Indeed, many
authors state that skipping BF results
in increased BMIs [e.g., Ref. (17, 18)]
although (as mentioned in the introduction) no causality has been established. Additionally, even the very existence of such a link is questioned.
While skipping BF has been linked to
higher risk of obesity in the UK (19),
Hong Kong (20), and the USA (21),
no such link was observed in Australia

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(22), Portugal (23), and Saudi Arabia (24).

A link between skipping BF and obesity
is constantly being challenged and in many
studies, a lack of this link was repeatedly
demonstrated (2432). In fact, the exact
opposite link was recently demonstrated:
in a large cohort, 4-year long study based
on Japanese insurance statistics (7), the
accumulation of newly diagnosed diseases
was plotted against various lifestyle-related
behaviors. Self-reported BF-skippers had a
lower incidence of all diseases (including
metabolic diseases) as compared to BFeaters. In the same study, a link between late
eating and poorer health was demonstrated
(Figure 1A).

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CONTROLLED STUDIES OF ENERGY

BALANCE
The supposed disadvantages of skipping BF
have not been supported by recent controlled studies. Kral et al. (14) directly
demonstrated that skipping BF caused an
increase in hunger levels but not in a
overcompensation of calorie intake later
in the day. On the contrary, Gonzalez
et al. (33) found that daily energy and
fat intakes were reduced with BF omission. Similarly, Levitsky and Pacanowski
(15) showed that, although skipping BF
significantly increased hunger ratings at
lunchtime, food intake at lunch were not
increased. Moreover, skipping BF resulted
in a net energy deficit of about 400 kcal a
day comparing to BF eating group. Levitsky and Pacanowski mention that 25%
of Americans now regularly skip BF in
order to lose weight compared to 14% in
1965, despite aggressive campaigns labeling skipping BF as one of the most harmful eating behaviors. The caloric intake
reduction due to skipping BF may offer
an explanation for why this practice for
successful weight loss works and is on
the rise. A similar mechanism of caloric
intake reduction due to skipping BF is
present due to abstaining from late eating, as demonstrated by LeCheminant
et al. (13).
Another component of energy balance
is energy expenditure. Recently, it was
shown that skipping BF did not affect
24-h energy expenditure, resting metabolic level, or food-induced thermogenesis (34). This seems to contradict the
description of BF-skippers as more sedentary, having decreased energy expenditure
[e.g., Ref. (35)]. However, it cannot be
excluded that a third factor exists which
underlies both skipping BF behavior and
sedentary lifestyle (36). In a recent Danish longitudinal study of 8- to 11-year-old
children, examining the causality between
being overweight and physically inactive, a
causality was indeed found, but the exact
opposite to what is commonly believed,
that adiposity is a better predictor of physical activity and sedentary behavior changes
than the other way around [(37), p. 1]. If
adiposity is, in fact, the reason for physical
inactivity, then by the same token, BF skipping may be a result of being overweight,
and not the other way around.

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Breakfast: to skip or not?

INDIRECT EVIDENCE OF THE

POTENTIAL BENEFITS OF SKIPPING
BREAKFAST
Comparing to evidence from the broader
field of nutrition, we can investigate a
potential overlap, which can shine light on
the potential benefits of skipping BF. In
terms of meal timing, skipping BF is similar to intermittent fasting (38), however,
it is seldom looked at from this point of
view. One of metabolic effects of intermittent fasting is intermittent ketosis known
for its appetite suppression effect (3941)
resulting in voluntary calorie reduction
[e.g., Ref. (42)]. BF skipping and exclusion of late eating, as described above, also
result in reduction of voluntary calorie
intake (15, 33). Calorie restriction has been
shown to have profound metabolic benefits including neuroprotective, anti-aging,
and anti-inflammatory [see Ref. (43) for
review]. Furthermore, Mattson and colleagues showed in rodents that intermittent
fasting had more metabolic benefits than
permanent calorie restriction (44), thus
skipping BF may be more beneficial than
traditional restrictive dieting.
CONCLUSION
Given body of evidence reviewed in this
opinion article, it is reasonable to suppose
that skipping BF could be as metabolically
beneficial as excluding late eating, as well
as stress the importance of the overnight
fast. Perhaps it does not matter which of
the daily meals the first or the last is
omitted as long as at least once in a while,
an inter-meal interval is long enough to
allow the state of ketosis to initiate lipolysis and lower calorie intake, thus decreasing
the risk of obesity and its comorbidities.
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Conflict of Interest Statement: The authors declare

that the research was conducted in the absence of any
commercial or financial relationships that could be
construed as a potential conflict of interest.

Received: 30 April 2014; accepted: 16 May 2014; published online: 03 June 2014.
Citation: Zilberter T and Zilberter EY (2014) Breakfast:
to skip or not to skip? Front. Public Health 2:59. doi:
10.3389/fpubh.2014.00059
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and Promotion, a section of the journal Frontiers in
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